Anterior communicating artery aneurysm clipping: Experience at a tertiary care center with respect to intraoperative rupture

Ramit Singh; Ravi Prasad; Rahul Singh

doi:10.4103/ajns.AJNS_308_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(04): 931-936
DOI: 10.4103/ajns.AJNS_308_20

Original Article

Anterior communicating artery aneurysm clipping: Experience at a tertiary care center with respect to intraoperative rupture

Ramit Singh

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

,

Ravi Prasad

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

,

Rahul Singh

Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh

› Institutsangaben

Abstract

Context: The incidence of anterior communicating artery (Acomm) aneurysm is high and it is associated with high risk of rupture. Aims: The aim is to evaluate various factors (size, wall morphology, and fundus direction) associated with intraoperative rupture (IOR) of Acomm aneurysm. Settings and Design: Retrospective cohort study. Subjects and Methods: Our study includes 25 operated patients diagnosed to have ruptured Acomm aneurysm in the Department of Neurosurgery of Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, between January 2016 and July 2020. Our study included all patients with ruptured Acomm aneurysm who received clipping as method of treatment. Statistical Analysis: Chi-square test was used for analysis. Values with P < 0.05 were considered statistically significant. Statistical tests were done using GraphPad Prism version 8.3.0 software. Results: None of the patients with <4 mm, 6 patients of >4–10 mm, and 2 patients of >10 mm aneurysm size experienced IOR. IOR was seen in 2 patients with smooth wall and 6 in irregular aneurysm wall. All patients with posterior, 1 patient with inferior, 2 patients with anterior, and 1 patient with superior directing aneurysm experienced IOR. Patients with bilaterally clipped A1 experienced no IOR, while in unilaterally clipped aneurysm only 2 patients experienced IOR. Glasgow outcome score was better in patients with no IOR. Conclusion: The factors associated with high risk of IOR are: Aneurysm size >4 mm, multilobulated or irregular aneurysm wall, posteriorly and inferiorly directed aneurysms. Patients in whom Both A1 was temporarily clipped, experienced no IOR and better outcome.

Key-words:

Aneurysm fundus direction - anterior communicating artery aneurysm - Glasgow outcome score - intraoperative rupture - temporary clipping

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